Energy

Requirements

Dr Inoka Uluwaduge (Ph D Biochemistry)

Dept. of Medical Laboratory Sciences
Faculty of Allied Health Sciences
Univ of Sri Jayewardenepura
OBJECTIVES
Define basal metabolic rate and
state the factors which influence
BMR
Calculate basal energy expenditure
of adult males and females
Learn the clinical conditions
associated with energy deficit and
excess
First Law of Thermodynamics-
Energy cannot be created nor destroyed, but can only be
changed between its different forms.

The body converts food energy (chemical energy) into

other forms.
CHO, fats, proteins and alcohol are oxidized in the body
and the energy released used for body functions.
 The energy requirement of an individual is,
Energy requirements
‘The level of energy intake from food that will balance
energy expenditure when the individual has a body
size and composition and level of activity consistent
with long term good health’ (FAO/WHO/UNU, 1985)

 Children and pregnant or lactating women need

additional energy requirement for deposition of tissues
and milk production
 Energy requirement and expenditure depends on
environmental and health conditions
 Units of energy
Joule
 SI unit of energy and heat
 work done by force of one ‘Newton’ acting over a
distance of one metre (1m)
 Expressed as Kilo joule (KJ)
 Calorie (Cal) or Kilo calorie (Kcal) were used previously
 1 kilojoule (kJ) = 1,000 joules

1 kilocalorie (kcal) = 1,000 calories

 1 kcal = 4.184 KJ
 Energy
Energy Balance

Energy intake Energy

Expenditure
episodic, mainly
from CHO, protein & Several
fat components
 Energy expenditure

The energy expenditure (EE) -over a whole day

by different components, which can be
individually determined

- Basal metabolic actvities-60-70 %

- Diet Induced Thermogenesis (DIT) -10 %
- Physical Activity –variable
(i) Basal metabolic activities –

 Constitute the largest component of energy

expenditure
 Refers to body activities at rest –

heart beat, respiration, liver and kidney function,

maintenance of body temperature etc.
 This is termed as basal metabolism
 This energy is ultimately dissipated as heat and
can be measured
 It is known as the basal metabolic rate (BMR)
(ii) Diet induced thermogenesis
(thermic effect of food (TEF) / post prandial
thermogenesis)

 Increase in energy expenditure after a meal

 Represent energy used for digestion, absorption,

transport and storage of ingested nutrients

 The amount of energy expended is about 5-10% total

energy expenditure. Depends on the nutrient
composition and the amount of food ingested. Spices
increase TEF, also caffeine & nicotine
(iii) Physical activities

(a) Occupational activities – can be divided as,

Heavy – laboures, athletes, farmers
moderate – students, housewives, workers in
light industry
Light – professionals, office workers

(b) Non- occupational activities/ discretional

activities (other activities)
Basal metabolic rate (BMR)
Basal Energy Expenditure (BEE)
 BMR is the energy expenditure of an
individual who is awake, wearing light clothes
in lying position, in a thermo neutral
environment at least 12 hrs after the last
meal, in “complete” mental & physical rest
 BMR is expressed in kcal/kg or kJ/kg body
weight
 BMR can be calculated if the age, height,
weight and sex of an individual is known
 Harris Benedict Equation
For males-
BEE = 66.7 + 13.8w + 5.0h – 6.8a (kcal)
For females-
BEE = 66.5 + 9.5w + 1.8h – 4.7a (Kcal)
w – weight in Kg
h – height in cm
a – age in years

The equation does not take into account lean body mass
or fat mass, so the equation is more effective for
individuals at an ideal body weight or close to it
Factors influencing BMR

 Genetics- some people have a faster

metabolisms
 Age – BMR is high in children and declines
with age
 Gender – At all ages BMR is slightly lower in
females
 Body composition – lean people have a higher
BMR
 Pregnancy – increases BMR
Factors influencing BMR

 State of nutrition – starvation and

under nutrition decreases BMR
 Endocrine effects – Thyroid hormones,
catecholamines increases BMR
 Body temperature – rise in body temperature
increases BMR
BMR factors associated with physical activities

Occupational activities -

female male
light 1.56xBMR 1.55xBMR
moderate 1.64xBMR 1.78xBMR
heavy 1.82xBMR 2.10xBMR
 Discretional activities

female male
sleeping 1.0 1.0
Sitting/ 1.4 1.4
standing
Household 2.5-3.0 3.0
tasks
Social 2.5 -3.0 3.0
activities
Activities of 6.0 6.0
physical
fitness
 Calculate the energy expenditure of a male clerk,
aged 25yrs, weighing 65kg with a BMR of 6072
kJ/day. His daily activities are as follows;

Activity Duration (hrs) BMR Factor

Sleeping 8 1.0
Office work 6 1.7
Discretionary 2 3.0
Fitness training 1 6.0
(1.4 BMR for residual activities)
BMR per hour = 6072/24 = 253 kJ/hr

Activity Duration BMR Factor EE (kJ)

Sleeping 8 1.0 2024
Office work 6 1.7 2581
Descretionary 2 3.0 1518
Fitness training 1 6.0 1518
Residual 7 1.4 2479

Total 24 10120 kJ
 Ifhis diet contains
200g of carbohydrate
150g of protein
200g of fat
Deduce his Energy balance.

(At water factor Kcal/g)

Carbohydrate= 4
Protein= 4
Fat= 9
 RDA’s for Energy –Sri Lanka
Energy (Kcal/d)
Infants 0-12 months 560-720
Children 1-6 yrs 875-1300
Children 6-9 yrs 1775
10 -11 (male) 2250
10-11 (female) 2100
12-18 (male) 2875-3375
12-18 (female) 2400-2500
Adults -18-30 (male) 2425 – 3375 (depending on activity)
(female) 1600 - 2800
30-59.9 2375 -3325
>60 1950 -2350
Pregnancy +360 - +460 (2nd -3rd trimester)
Lactation +675 (1-6months) ,+460 (>6
months)
 Energy deficiency

Energy deficiency –major issue

Majority of young children & adolescents –ve
energy balance
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Protein- energy (calorie)

malnutrition (PEM)
 Seen in children or the elderly who are
malnourished
 In developing countries, an inadequate
intake of protein and/or energy is the
primary cause of PEM
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PEM
 Affected individuals show a variety of symptoms,
including a depressed immune system with a
reduced ability to resist infection
 Death from secondary infection is common
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PEM
 Two extreme forms
1. kwashiorkor
2. marasmus
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Kwashiorkor
 Sufficientcalorie intake, but with insufficient
protein consumption, distinguishes it from
marasmus
 Usually affects children beyond the age of 12
months (frequently seen in children after weaning at
about one year of age, when their diet consists
predominantly of carbohydrates)
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Kwashiorkor-Typical symptoms
stunted growth, oedema, anorexia (laziness), skin lesions
(hyperpigmented and sometimes broken), depigmented hair (thin
dry hair that is easily pulled out and is brownish red in colour),
enlarged fatty liver, decreased plasma albumin concentration
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Kwashiorkor
 Affects the visceral compartment, the protein stores
of organs such as the liver
 Reduced synthesis of digestive enzymes and plasma
proteins, which leads to GIT atrophy of mucosa
lining and intestinal villi (where absorption takes
place)
 This leads to malabsorption and thus diarrhea,
which leads to loss of electrolytes such as potassium
(Treatment oral rehydration solution)
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A child with
Kwashiorkor
shows a
deceptively
plump belly as
a result of
oedema

In the liver, reduced protein and increased fat leads

to hepatomegaly. Reduced plasma protein leads to
reduced oncotic pressure, which causes fluid shift
from intravascular spaces to extravascular spaces,
causing oedema. Oedema may mask muscle loss
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Flaky paint dermatitis

 Flag hair in kwashiorkor
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Marasmus
 Occurs when calorie deprivation is relatively
greater than the reduction in proteins
 Usually affects children aged 6 months to 1 year
when breast milk is supplemented with watery
gruels of native cereals that are usually deficient in
protein and calories
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Marasmus
 Thyroxin decreases to reduce the metabolic rate.
Insulin also decreases to maintain blood sugar
levels
 Muscles and body fat are broken down to ensure
energy requirements are met
 Typical symptoms include arrested growth,
extreme muscle wasting (emaciation), weakness,
and anemia
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Marasmus
 Victims of marasmus do not show the edema or
changes in plasma proteins observed in
kwashiorkor
 The skin is dry and wrinkled and looks too big for
the body (baggy pants sign), but does not break or
change color
 May have Vitamin A deficiency (Bitot's spot sign)
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A child is considered to have marasmus when

weight level falls to 60% of normal for sex, height,
and age
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OBESITY
A disorder of body weight regulatory systems
characterized by an accumulation of excess body
fat due to imbalance between E intake and
expenditure
 In primitive societies, in which daily life required
a high level of physical activity and food was
only available intermittently- obesity was rare
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Current situation
 Today,however, the sedentary lifestyle and
abundance and wide variety of palatable,
inexpensive foods in industrialized societies has
contributed to an obesity epidemic
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Impact of obesity
 Adiposity has increased so has the risk of
developing associated diseases, such as arthritis,
diabetes, hypertension, cardiovascular disease,
and cancer
 Particularly alarming is the explosion of obesity in
children and adolescents
 There are more obese than undernourished
individuals worldwide
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ASSESSMENT OF OBESITY
 The amount of body fat is difficult to measure
directly
 Usually determined from an indirect measure—the
body mass index (BMI)— which has been shown
to correlate with the amount of body fat in most
individuals
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BMI
 The BMI provides a measure of relative weight,
adjusted for height
 BMI= weight in kg

height in meters2
 This allows comparisons both within and between
populations
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BMI
 18.5 -24.9 -healthy
 25 - 29.9 -overweight
 ≥30 - obese
 › 40 – extremely obese
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BMI Chart
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Anatomic differences in fat

deposition
 The anatomic distribution of body fat has a major
influence on associated health risks
 Excess fat located in the central abdominal
area= android, apple-shaped, upper body
obesity
 Are associated with hypertension, diabetes,
dyslipidemia and coronary heart diseases
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Anatomic differences in fat

deposition
 Fatdistributed in the lower extremities (gluteal
region) = gynoid, pear shaped, lower body
obesity
 Waist › 0.8 women, › 1.0 men= android

Hip
‹ 0.8 women, ‹ 1.0 men= gynoid
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Anatomic differences in fat

deposition
 The pear shape, more commonly found in
women, presents a much lower risk of metabolic
disease
 Thus, the clinician can use simple indices of body
shape to identify those who may be at higher risk
for metabolic diseases associated with obesity
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Body fat deposits

1. Subcutaneous fat - 80–90% of the fat stored in

the human body is in subcutaneous depots,
just under the skin, in the abdominal (upper body)
and the gluteal-femoral (lower body) regions
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Body fat deposits

2. Visceral depots
10–20% of body fat is stored in so-called
visceral depots (omental and mesenteric)
which are located within the abdominal
cavity in close association with the
digestive tract
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Body fat deposits

 Abdominal fat cells are much larger and have a
higher rate of fat turnover than lower body fat
cells
 Abdominal fat cells are hormonally more
responsive than fat cells in legs and buttocks
 Men tend to accumulate the readily mobilizable
abdominal fat, they generally lose weight more
readily than women
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Size and number of fat cells

 As triacylglycerols are stored, adipocytes can expand to an
average of two to three times their normal volume
 The ability of a fat cell to expand is limited
 With prolonged over nutrition, pre-adipocytes within
adipose tissue are stimulated to proliferate and
differentiate into mature fat cells, increasing the number of
adipocytes
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Size and number of fat cells

 Thus, most obesity is due to a combination of
increased fat cell size (hypertrophy) and
number (hyperplasia)
 With weight loss in an obese individual, the size
of the fat cells is reduced, but the number of fat
cells is not usually affected
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Size and number of fat cells

 Thus, a normal body fat is achieved by decreasing
the size of the fat cell below normal
 Small fat cells are very efficient at re
accumulating fat, and this may drive appetite
and weight regain
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Genetic contributions to obesity

 Often observed clustered in families
 If both parents are obese, usually their children are
obese
 Identical twins have very similar BMI whether
reared together or apart, and their BMI are more
similar
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Environmental and behavioral

contributions
 Ready availability of palatable, energy-dense
foods,
 sedentary lifestyles encouraged by TV watching,
automobiles, computer usage, and energy-saving
devices in the workplace and at home, decrease
physical activity
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Eating behaviors
 snacking, portion size, variety of foods consumed,
an individual’s unique food preferences, and the
number of people with whom one eats also
influence food consumption
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MOLECULES THAT INFLUENCE

OBESITY –Long term signals
Leptin
Secreted by fat cells and acts on the
hypothalamus (satiety and hunger center) to
regulate the body fat through the control of appetite
and energy expenditure
 Leptin is produced in proportion to the adipose
mass cell and inform the brain about body fat stores
 60 08/18/20

MOLECULES THAT INFLUENCE

OBESITY
 Insulin:Obese individuals are also
hyperinsulinemic
 Like leptin, insulin acts on hypothalamic neurons
to reduce appetite
Short-term signals
 From the gastrointestinal tract control hunger and
satiety, which affect the size and number of
meals over a time course of minutes to hours
 In the absence of food intake (between

meals), the stomach produces ghrelin, an

orexigenic (appetite- stimulating)
hormone that drives hunger
Short-term signals …..
 During a meal, as food is consumed, gut
hormones,
cholecystokinin (CCK)
peptide YY (PYY),
through gastric emptying
cause satiety and meals are terminated
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Appetite
stimulating
hormone
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METABOLIC CHANGES
OBSERVED IN OBESITY/
Metabolic syndrome

Includes glucose intolerance, insulin resistance,

hyperinsulinemia, dyslipidemia (low high-density
lipoprotein (HDL) and elevated triacylglycerols), and
hypertension
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Dyslipidemia
 Insulin resistance in obese leads to production of
more insulin to maintain body glucose levels
 Insulin acted on adipose tissues causes an
increased activity of hormone-sensitive lipase-
causes lipolysis- increase level of free fatty acids
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Obesity and health

 Correlated with an increased risk of death and is a
risk factor for a number of chronic conditions,
including type 2 diabetes, dyslipidemias,
hypertension, heart disease, some cancers,
gallstones, arthritis, gout, and sleep apnea
 The relationship between obesity and
associated morbidities is stronger among
individuals younger than 55 years
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Weight reduction
 The goals of weight management are
to induce a negative energy balance
to reduce body weight
(reduce caloric intake/ increase energy expenditure)
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Weight reduction
 An increase in physical activity can create an
energy deficit
 Exercise is a key component of programs directed
at maintaining a weight loss
 Caloric restriction- Dieting is the most commonly
practiced approach to weight control- weight loss
on calorie-restricted diets is determined primarily
by energy intake and not nutrient composition